Zinc deficiency

Symptoms Of Zinc Deficiency

The symptoms of zinc deficiency start appearing after months of having low levels of zinc. The symptoms vary as per the levels of zinc and are non-specific, often resembling other medical conditions. Therefore, it is necessary to conduct a medical examination for confirmation.  

People with zinc deficiency may experience:

• Skin rash

• Skin ulcers

• Hair loss

• Diarrhea

• Frequent cold and infections

• Weight loss

• Delayed wound healing

• Decrease in the sense of smell or taste

• Loss of appetite

• Eye and skin lesions

• Vision problems

• Mental lethargy

• Hypogonadism (in males)

• Impotence

In children and adolescents there can be:

• Growth retardation

• Delayed puberty

• Difficulty in learning

Causes Of Zinc Deficiency

Zinc deficiency is mostly seen in developing and underdeveloped countries due to malnutrition. However, cases are also seen in developed countries as a result of various chronic illnesses. Zinc deficiency can be acquired or congenital.

Acquired zinc deficiency

The main causes of acquired zinc deficiency can be: 

• Decreased intake of zinc

• Decreased absorption of zinc

• Increased demand of zinc

• Excessive loss of zinc

1. Decreased intake of zinc

Inadequate intake of zinc is mostly related to:

• Low intake of zinc rich foods
• Strict vegetarian diets
• Parenteral nutrition
• Anorexia nervosa (eating disorder)

A person may also have zinc deficiency even if he/she is taking adequate amounts of zinc. This can be due to the excessive consumption of certain food items or medications which can hinder the absorptions of zinc, and presence of certain disorders. These include:

• Phytates containing foods such as legumes, seeds, soy products, and whole grains
• Oxalates containing foods such as spinach, okra, nuts, and tea
• Calcium and phosphates containing foods such as dairy, nuts and seeds
• Medications such as thiazide diuretics (chlorthalidone or hydrochlorothiazide), sodium valproate, antibiotics, and penicillamine
• Diseases such as Crohn’s disease, short bowel syndrome, hookworm infestation and pancreatic insufficiency

3. Increased demand of zinc

The demand of zinc increases during pregnancy and lactation as it is required in the growth and development of the baby. The demands of the body increases as below:

• Pregnant women (18 years of age and younger): 12 mg per day

• Pregnant women (19 years of age and older): 11 mg per day

• Breastfeeding women (18 years of age and younger): 13 mg per day

• Breastfeeding women (19 years of age and older): 12 mg per day

Zinc, if not taken in adequate amounts during pregnancy and breastfeeding, can cause certain fetal defects and low birth weight.

Are you eating the right type of food during pregnancy? Read in detail about various foods that should be eaten and avoided for a healthy pregnancy. 
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4. Increased loss of zinc

In some cases, there can be excessive loss of zinc from the body which can also be a cause of zinc deficiency. This includes:

• Dialysis

• Hemodialysis

• Hemolysis

• Diarrhea 

• Urinary loss (due to diuretics or alcohol use)

Congenital zinc deficiency 

Although zinc deficiency is commonly caused by dietary factors, several inherited conditions have also been found. Acrodermatitis enteropathica is one of the common inherited condition seen in humans.

Acrodermatitis enteropathica: It is a rare form of zinc deficiency.which causes impaired absorption of zinc. It occurs in both congenital and acquired forms. The congenital form results from intestinal disorders due to genetic abnormality, whereas the acquired forms can result due to: 

• Lack of secretion of zinc in the breast milk

• After surgery of intestine

• Adopting special intravenous nutritional programs 

Risk Factors For Zinc Deficiency

People with gastrointestinal disease 

There is a decrease in the absorption of zinc in people suffering from gastrointestinal disease such as ulcerative colitis, Crohn’s disease, and short bowel syndrome. People with these diseases or those who have undergone gastrointestinal surgery are more prone to zinc deficiency. 

Certain diseases

Some diseases may decrease the zinc absorption and increase the loss of zinc, making the patient vulnerable to zinc deficiency. These include sickle cell anemia, chronic kidney disease, liver disease, chronic diarrhea, HIV infection, diabetes, malabsorption syndrome and cancer. 

Vegetarians

The absorption of zinc from vegetarian diets is less than non-vegetarian diets. Also, the food consumed by vegetarians mostly contains phytates that inhibit the absorption of zinc. Due to this, vegetarians are at a higher risk of developing zinc deficiency.  

Pregnant and breastfeeding women

Zinc is required for fetal growth and development. Pregnant and breastfeeding women are at high risk of zinc deficiency due to high fetal demand during this phase. 

Alcoholics

About 30-50% of people who consume alcohol suffer from zinc deficiency as alcohol decreases the absorption of zinc and increases its excretion in urine. 

Malnutrition

Zinc is a micronutrient that cannot be synthesized by the body. It has to be taken from outside sources. People living in developing or underdeveloped countries have a limited access to thsese food which increase the risk of zinc deficiency. 

Consuming excessive fiber 

An adequate amount of fiber in the diet is very essential for a healthy digestive system. But, excessive consumption of fiber can also hamper the absorption of essential nutrients such as zinc. 

Old age

The elderly people especially above 75 years of age are at a higher risk of having zinc deficiency. This is because of slow metabolism, poor appetite, and less diversification in the diet. 

Stress

Prolonged stress is also found to reduce the levels of zinc in the body. 

Exclusively breastfed older infants

Breast milk provides 2 mg/day of zinc which is sufficient only for initial 4-6 months. The dietary requirement for zinc for the older infants aged 7-12 months increases. At this age, if the infant is only having breast milk they can suffer from zinc deficiency. 

Diagnosis Of Zinc Deficiency 

Blood tests

Zinc level: This test checks the amount of zinc in the blood which does not necessarily reflect its level within the cells. Zinc deficient people can have normal zinc levels in the blood. The level also varies as per circadian rhythm, drugs and meals taken. It is usually high in the morning and low in the evening. The normal range is 0.60-1.20 mcg/mL for children and 0.66-1.10 mcg/mL for adults. 

In the presence of zinc deficiency, the absorption of copper is increased. Alongwith the serum level of zinc, levels of copper and serum copper/zinc ratio is also measured. Serum copper level over 120g/dl and  a serum copper/zinc ratio of 1.5 also indicate zinc deficiency. 

Additionally, several blood tests are also done to rule out other conditions or vitamin deficiencies. These include: 

• Complete blood count (CBC)

• Serum electrolytes

Oral zinc tolerance test: In this test, the levels of zinc are measured after administering zinc. This test helps to detect zinc deficiency caused due to decreased absorption of zinc in the body.  

Zinc dependent enzymes: The activities of various zinc-dependent enzymes are also measured to assess zinc deficiency. Alkaline phosphatase, carboxypeptidase, and thymidine kinase are three such enzymes. A quantitative measurement of these enzymes also gives an idea of zinc deficiency. 

Urine tests

The excretion of zinc in urine is decreased as a result of zinc deficiency. The determination of zinc in a 24-hr urine sample also helps in diagnosing zinc deficiency. However, this is not a reliable method for determining acute cases of zinc deficiency. 

Hair analysis 

Zinc level is also measured in hair. Chronic zinc deficiency is reflected more accurately in hair than in blood.

Specialist To Visit

Although zinc deficiency is not an emergency condition, you may consult the doctor in case you:

• Have nausea

• Have consistent headache

• Experience unconsciousness

• Have diarrhea from several days

If you are pregnant or breastfeeding, and suspect deficiency of zinc, consult your doctor immediately as zinc plays an important role in the growth and development of the fetus and newborn baby. 

Specialists you may consult are:

• General physician 

• Internal medicine specialist

• Gynecologist (in case of pregnancy and breastfeeding women)

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Prevention Of Zinc Deficiency

Zinc deficiency can be easily prevented by taking the recommended amount of zinc either through dietary sources or supplements. 

• Oysters contain the maximum amount of zinc per serving compared to any other food. 

• Beef, red meat, poultry, and certain types of seafood (such as crab and lobster) also have a good amount of zinc.

• Many grains, plants and dairy based foods are also good sources of zinc. These include  oats, legumes, chickpeas, beans, cashews, almonds, peas, chia seeds, and pumpkin seeds.

Treatment Of Zinc Deficiency

Patients suffering from zinc deficiency can manage it by increasing the intake of zinc through diet. If dietary modifications fail to show any improvement in your condition, your doctor might recommend supplementation.  

1. Supplementation

The treatment of zinc deficiency usually begins with oral supplementation which has proven to reduce the symptoms. The recommended daily intake of zinc is:

• 3 mg/day for children less than 4 years

• 5 mg/day for children between 4 to 8 years

• 8 mg/day for children between 9 to13 years

• 11 mg/day for men

• 9 mg/day for women (non-pregnant and non-lactating)

• 11 to 12 mg/day for pregnant women 

Higher doses of zinc (more than 50 mg/kg) is required in patients who have severe deficiency. It is mostly needed in patients having chronic illnesses such as Crohn's disease and short bowel syndrome. High levels of zinc can interfere with copper and iron metabolism, so it is important to monitor the levels of zinc regularly in the patients taking zinc supplements. Supplements are taken for a lifetime in a condition called acrodermatitis enteropathica. 

Zinc supplements are available in the form of:

• Zinc sulfate

• Zinc acetate

• Zinc aspartate

• Zinc orotate

• Zinc gluconate

Parenteral zinc supplementation is recommended in rare cases such as intestinal failure or if the patient is on total parenteral nutrition (TPN).

Interactions of zinc supplementation with medications

• Antibiotics: Antibiotics such as quinolone & tetracycline antibiotics inhibit the absorption of zinc. It is advised to take these antibiotics at least 2 hours before or 4–6 hours after taking a zinc supplement to minimize this interaction. 
• Penicillamine: Penicillamine is a drug used to treat rheumatoid arthritis. It also reduces the absorption of zinc. Patients should take zinc supplements at least 2 hours before or after taking penicillamine to reduce the interaction. 
• Diuretics: Some diuretics such as chlorthalidone and hydrochlorothiazide increase urinary zinc excretion. Prolonged use of these diuretics may affect the zinc levels adversely. So, the zinc status should be carefully monitored in patients who are on diuretics. 
  

Complications Of Zinc Deficiency

1. Age-related macular degeneration (AMD): AMD is an eye disorder that causes vision loss. Studies suggest that zinc supplements help in the slow progression of AMD. 

2. Growth failure: Since zinc is required for normal growth and development of the child, a low level of zinc for a long period of time can hamper its overall growth and development. 

3. Skin problems: Skin complications associated with zinc deficiency include acrodermatitis enteropathica, cheilitis, and dermatitis.

4. Diabetes mellitus and obesity: A prolonged and severe zinc deficiency is also associated with an increased risk of diabetes and obesity. The exact mechanism behind this correlation is not known. 

5. Attention deficit hyperactivity disorder (ADHD): Zinc deficiency in children can cause ADHD in children. ADHD is accompanied by lack of activity and impaired socialization in children. 

Read more about other causes, symptoms and management of ADHD.

Other complications associated with zinc deficiency are:

• Delayed wound healing

• Recurrent infections such as pneumonia and malaria

• Low bone mineral density

• Hypogonadism

• Herpes simplex virus infections

• Wilson’s disease

• HIV infection

• Acne

• Diarrhea

Zinc has antioxidant properties which protect from free radicals. Low levels of zinc also increases the risk of cancers and heart disease. 

Note: Maternal zinc deficiency during pregnancy can cause abortion, preterm bith, still birth and fetal neural tube defects. Babies born to such mothers have low birth weight.

Is there any relation between zinc deficiency and COVID-19?

Zinc also possesses antiviral and antiinflammatory properties. Deficiency of zinc may reduce the immunity (the ability of the body to fight infections). People with low levels of zinc are more prone to coronavirus infection. Zinc supplementation is hence used as an adjuvant therapy in faster recovery, treatment and prevention of COVID-19 because of its following potential benefits. Zinc helps by:

• Restricting the entry of virus in the body

• Inhibiting multiplication of the virus

• Modulating immune response

To know more about COVID-19, its treatment & latest updates/news, check out our coronavirus section.
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Alternative Therapies For Zinc Deficiency

Home remedies

1. Holy basil (Tulsi): It is considered as the “Queen of herbs” in Ayurveda. It  contains zinc along with Vitamin A and C, calcium, and iron. 

2. Indian pennywort (Brahmi): It is an Ayurvedic herb that is rich in zinc. It is known to exhibit antioxidant properties which helps in increasing memory, concentration, and brain power. 

3. Asparagus racemosus (Shatavari): It is known for its fertility properties but it is also a very good source of zinc. It contains 0.54 mg zinc per 100 gm serving. It boosts immunity and also helps to fight stress, anxiety, and depression.

4. False daisy (Bhringraj): It is known for its moisturizing and nourishing properties. It is also a source of zinc along with other micronutrients such as copper, sodium, iron, and potassium. 

Homeopathy

Several homeopathic medications such as Zincum aceticum and Zincum metallicum are also available for zinc deficiency. 

Living With Zinc Deficiency

Zinc deficiency can be easily reversed through proper supplementation and diet. You can keep the following points in mind while managing zinc deficiency.

Cook your food wisely

Changing the way of cooking certain foods can increase the absorption of zinc. For example soaking beans before cooking or leavening foods can lower the phytates concentration, making it easier for the body to process zinc. 

Consult a doctor 

A person having zinc deficiency can have other nutritional deficiencies. Consult your doctor as soon as you notice any other symptoms of nutritional deficiencies. 

Be cautious of toxicity

Overdose of zinc supplements can also cause toxicity and lead to symptoms such as nausea and vomiting. To avoid this, zinc supplements should always be taken as per your doctor's recommendation. The dose of zinc varies as per your age and other conditions such as pregnancy and breastfeeding. The patients who are on zinc supplements should get their zinc level tested every three months.

Do not self medicate

Before taking any zinc supplement, talk to your doctors as the dose varies as per your medical condition. The dose also varies, if you are on some other medications. 

Avoid certain foods

The foods that are high in calcium and phosphorus such as milk, cheese, yogurt, dried beans, lentils, and nuts delay the absorption of zinc. So, avoid taking zinc supplements with such food items. 

Be aware of allergy

Some patients taking zinc supplements can have allergy reactions which can be experienced as: 

• Hives

• Difficulty in breathing

• Swelling of face, lips, tongue, and throat

• Upset stomach

Consult your doctor immediately, if you have any of these symptoms. 

Manage the interactions with medications

Certain medications such as antibiotics, penicillamine, and chlorthalidone can reduce the absorption of zinc in the body. It is very important to discuss all the dietary supplements and medications you are already taking before initiating zinc therapy.